posted by Alicia Caramenico
on June 9, 2016
Delivering the highest value cancer care to patients can come with challenges. Not only do patients face a frightening, often life-changing diagnosis, but providers and health plans must work together to answer a myriad of sometimes difficult questions, like selecting the right treatment options and finding the best site of care.
To address oncology care challenges and improve quality, value, and patient experience, Harvard Pilgrim teamed up with Dana-Farber Community Cancer Care in July 2012 to create a Specialty Medical Home Pilot. Clinicians, operations, and medical informatics staff from Harvard Pilgrim and Dana-Farber worked together to establish transparency and trust. They agreed upon key quality metrics, how to measure success, and how to link performance to reimbursement.
Initial results from the pilot have been promising. For example, fewer patients are receiving chemotherapy in the last two weeks of life and more patients are using hospice care when appropriate. Clinicians are adhering to national clinical pathways and guidelines for breast and colon cancer, and the creation of an oral chemotherapy medications compliance program is helping to ensure patients take their medicines as prescribed.
With respect to cost and utilization, the pilot reduced total medical expense 6.9 percent below the baseline and 20.6 percent below the community oncology comparison group. In fact, the pilot performed better than the baseline and comparison group for key drivers of high cost, including emergency room use, chemotherapy, imaging, and radiation therapy.
The pilot also enhanced patient experience, with patients reporting very high scores on physician communication, access, and support staff. An oncology-specific patient experience survey identified additional opportunities for improvement, such as reducing waiting room times and focusing more attention on patients’ emotional and behavioral health.
In addition to forging a strong relationship between Harvard Pilgrim and Dana-Farber, the oncology practice earned Patient-Centered Specialty Practice recognition from the National Committee for Quality Assurance (NCQA) for its ability to manage and coordinate high-quality, cost-effective oncology care.
Note: This content was based on presentations at the AHIP Payment Reform Summit in October 2015.